Editorial: Bill to set dialysis clinic ratios does more harm than good East Bay Times August 1, 2017 As nearly every college student who studied psychology in the 1960s and ’70s knows, Abraham Maslow updated and popularized the trope “if all you have is a hammer, everything looks like a nail.” The phase is as true today as it was then, especially when talking about the California Legislature. It is there that lawmakers are being asked to pass SB 349 by Sen. Ricardo Lara that would establish the strictest-in-the-nation staffing for nurses and technicians in dialysis clinics. On the surface, this sounds like dandy reform. People who must go through the hours-long rigors of kidney dialysis several times a week deserve to have that effective treatment. And it might be a fine reform except that it is dangerous to patients (especially poor ones), will increase costs and likely won’t improve quality. There is, of course, a back story here. You see, Lara desperately wants to become California’s next insurance commissioner. He is already running for the office that will be decided next year. Then we have the interests of the United Healthcare Workers, who are pushing the effort. They have been trying, unsuccessfully so far, to unionize clinic workers, which explains the whole hammer and nail thing above. They perceive that there is some sort of problem among the state’s dialysis clinics and want this new set of draconian rules. The problem is, that narrative doesn’t fit with the facts. First, there is no empirical evidence that such staffing changes result in better care. On the contrary, there is statistical evidence from the Centers for Medicare and Medicaid Services that indicate California’s dialysis clinics rate higher in quality and patient satisfaction than clinics in other states that have such mandatory ratios. In addition, California and Oregon are tied with the lowest infection rates in the U.S. Second, establishing such ratios imposes significant new costs on clinic operations. Those who can’t afford to cover those costs will see fewer patients. Clinics in rural areas and low-income communities that treat large numbers of patients on Medi-Cal, where the reimbursement rate doesn’t cover the cost of care, are the most likely to cut services. It naturally follows that the reduction in available clinic spots forces more dialysis patients to the state’s emergency rooms, which is the most expensive way to deliver such service. The Senate Appropriations Committee analysis came to the same conclusion when it examined this issue. Finally, it is important to note that renal physicians, nurses, patients, veterans groups, the National Kidney Foundation and the California Dialysis Council oppose this bill. Loudly so. These are the interest groups that are the most impacted by the changes that would be advanced in this bill. They are against SB 349 and so are we.